Trisha Williams (Host 1): Hi, guys. Welcome to the Advanced Practice Perspectives Podcast. I'm Trisha Williams.

Tobie O’Brien (Host 2): And I'm Tobie O'Brien. This is a podcast created by Advanced Practice Providers for Advanced Practice Providers. Our goal is to provide you with education and inspiration. We will be chatting with pediatric experts on timely key topics and giving you an inside look at the various advanced practice roles at Children's Mercy.

Host 1: We are so glad that you're joining us today. So, sit back, tune in and let's get started.  

Today, we are so pleased to have Stacey Shoman with us. She is a pediatric nurse practitioner who practices primary care at Premier Pediatrics. Welcome to the podcast, Stacey.

Stacey Shoman, MSN, CPNP: Hello, thank you for having me. I'm so glad to be here.

Host 2: Absolutely. Stacey, tell us a little bit more about yourself.

Stacey Shoman, MSN, CPNP: Well, I came to Kansas City in high school, originally raised on the east coast. Got my undergraduate degree at Pittsburgh State University where I met Trisha. Um, yes, go Gorillas. Worked originally at Children's Mercy Hospital on an inpatient unit for about 10 years, when I went back to get my master's degree at UMKC.

Graduated with that in 2006, so since then I've mostly been working in the community, doing primary care pediatrics in an office setting, a community office setting. So I've been doing that for about 16 years now. And that's really all the excitement.

Host 2: Well, Stacey, we are glad that you're joining us for this podcast. I don't know if you've had a chance to listen, but we typically have interviewed people that work within Children's Mercy. So it's a lot of specialty care. So we are so excited to have someone from our community that works in an office setting. I only did three years of primary care in an office setting.

I loved my job. So I'm excited to talk with you more about what it's like. And then we're going to talk more also about how we can work together, how we already work together and how we hope to better work together. So, we were going to first start by asking you some of your favorite parts of working in an office setting out in the community.

Stacey Shoman, MSN, CPNP: Yeah, absolutely. So when I first got out of graduate school, I did work for one year in the hospital in pulmonology as a Nurse Practitioner. And I loved my patients, but I was ready for more variety. One of the major things I love about primary care is it's so different every day and there's so many different things to see, but I also love getting to connect with my own community.

 So I see neighbors, I see you know, my children's friends may come in. I see people I went to high school with and I get to see their children. And I love getting to connect with the families and watch the kids grow up. It's really kind of a cool thing, especially as, you know, my kids are, I have two teenagers, as they're getting older, it's just been really cool to watch these kids kind of grow up and just establish rapport with a family.

So I really love that. And I love getting to see them at the store and run into them, you know, at the mall. And, it's just really kind of a cool bond that you get to form with your families and you're doing more of the well side. You know, in the hospital, I always felt like I was dealing with the abnormal, whereas in primary care, I'm really more working with the well people kind of education.

sick walk-in clinic during the day that I work on top of my physicals. So I do get to see my share of, you know, ill visits, but I love getting to do more health maintenance and things like that as well. So there's just a lot of variety, a lot of variety and a lot of connection you make.

Host 2: Oh, I love that. It's just like you're investing in their lives. You know, you just get to be so invested. Oh, I bet they love you too. So,

Stacey Shoman, MSN, CPNP: I hope so.

Host 2: I'm sure they do. Well, so, it sounds like you get to see a lot of variety. Tell us a little bit about, if there's anything that are just extra tough working out in the community, in a primary care setting. Is there anything that you're like, oh, this is just like what I don't love about it?

Stacey Shoman, MSN, CPNP: Absolutely. Yeah. One of the biggest barriers in primary care, I think for us is insurance. And I think you probably see that on the hospital side as well. But a lot of times there's so many insurance mandates, as far as say ADD. So I have a kid that's got ADD. I know his sibling did horrible on a certain medication and has been through three or four, and I might want to try, you know, something that worked well for brother.

But sister, they have to go through two different medications that they failed prior to insurance covering, say, this medication. And so I think that makes it really hard because often there are things that we know will work better that we can't use, because insurance requires certain steps first. And so I think that's really hard.

It doesn't allow us to practice as we would always want to. Sometimes we have to, you know, alter our plan based on what insurance says they will cover. And that's probably one of our biggest barriers, is insurance. Another big barrier that we do see, as I'm starting to see, and I'm not sure if it's coming out of COVID. I'm really not sure what spurred it so much recently. But I'm starting to get a lot of vaccine pushback again. And so I'm starting to get a lot of that. All of a sudden, really in the last two years, a lot of parents wanting to do alternate vaccine schedules or just not wanting to do vaccines at all.

And that's been fairly new. I'm not sure if the primary care clinics at Children's Mercy are facing that as well, but, that's probably been the next, big barrier for us is vaccinations, secondary to insurance, I would say.

Host 2: Both of those things make sense. I think, just dealing with insurances and the sort of sidesteps or the, the little algorithm that you have to sort of go through to get what you actually need to do is certainly challenging. I agree with completely. And then, you know, that is interesting about the vaccine. I am not sure, but it does sure make it difficult because you have to do the extra education then and then it's just so much time. I'm sure that's, you have to see so many patients and I'm sure your schedule is jam packed full. And so taking the extra time to talk with parents and to educate them on like the proper education or why or why not that might work with your schedule at your office. I'm sure a big challenge.

Stacey Shoman, MSN, CPNP: It is. And often, you know, I have enough experience, when I worked at Children's Mercy, on the floor, I was on a primarily infectious disease floor. So I've seen a lot of preventable, vaccine preventable illnesses, pertussis, meningitis, super infected chicken pox, you name it, we saw it, you know, rotavirus. Man, we were back in the day before the rotavirus

Host 2: For sure.

Stacey Shoman, MSN, CPNP: And we would see infants admitted daily with dehydration from rotavirus. And so, I've seen it. And a lot of times if I can just share that with families, then they're like, oh yeah, I guess I'll see that. I guess I see that side of it.

And often you can convince them, even in an alternate schedule, right, to get started. Although that's not my favorite either. But some families just come in and you're not going to change their minds. And that's hard, because that requires a lot of education. Sometimes they'll bring me articles they've found on a website.

You know, I think that's another kind of barrier to primary care too. Really to any medical field right now is access to social media, the internet, which can be great but can also be bad. Because parents will find things on sites that aren't legitimate sites, that they just take to heart. You can find about anything you want on a website.

You know what I mean? And so they'll bring the articles from a site that's not a credible site. And then you have to take the time to look at the article and look at the site. And, but often those families are just not going to be convinced. And it is what it is, you know, it doesn't hurt my feelings, but we don't agree and that's okay.

Host 2: I know. Those are very challenging situations. And right, at some, at some level, it is just providing them with facts and then they are going to choose what they are going to choose. But yeah, just making sure that they are getting factual information sounds like it's so important.

Stacey Shoman, MSN, CPNP: Absolutely. Absolutely.

Host 2: Well, I love that we're getting to talk with you because, we've had so many guests that are subspecialty kind of areas, and so we love that we're going to get to work with our community nurse practitioners just to kind of find out, like, what are ways that we can help support you guys in the community?

Like, are there certain things that you feel like, gosh, I wish that we could work closer with this clinic, that clinic or things that you feel like, okay, I'd love a little bit more information about referrals for this reason or that reason. I just was curious. I was going to pick your brain about that.

Stacey Shoman, MSN, CPNP: Yeah, absolutely. So I love the portal through Children's Mercy. We use that a lot. I'm constantly logging into my patient connections, seeing what's going on, and that's very helpful. Although it's not always, you know, not all the subspecialtists are great about getting notes in, you know, very quickly.

 And I think the online medicine piece is amazing and helping us get information. But I think you also lose a little of the personal interaction. Does that make sense? Like, if you remember back in the day when I worked on the floor, anytime a kid got admitted, the primary physician was called on the admission, right?

And so that was such a personal connection. Now, obviously that's not realistic forever, right? Because you have such more volume, a larger volume of patients and so forth. What I would love to see, and it's interesting, I poled some of the, my co workers, and we talked about this, and I've actually brought this up to Michelle McMillan before, who's our physician liaison with Children's Mercy, was I would, I really wish, you know, we have the 1 800 GO MERCY, which we can call a subspecialist if we need to talk to them about something, maybe even admission, something acutely going on in the office. I've got a kid that's severely anemic, I want to talk to a hematologist and they're great with that.

But I always feel awful paging somebody, for something silly, right? I would love to see some sort of a portal, a provider portal, where you could email a message to say, you know, a physician or a physician's nurse, even, and be like, Hey, you know, I see you're taking care of this patient, I wanted to ask you outpatient follow up, what would you like us to be doing, because sometimes that might not be very clear.

Or I'm working this patient up for PCOS, what other labs would you maybe add? But it's not something where I might need to page somebody, like say a GYN, and pull her out of what she's doing to talk to me on the phone, but maybe I could shoot her an email that I would get back with in the next week or so, that would help answer a few questions for me.

 I don't know how that would work, and I don't know how that would look, but I would love that. I would love to just be able to reach out to an individual. And I know people's emails are on like the website and stuff like that, but I think it'd be hard for them to be inundated with personal emails.

Host 2: Stacey, I love that idea. I don't know how it looks either, honestly, but I know on the other side of things, there have been many times that I've wanted to touch base with the primary care provider and just say, hey, I, you know, you sent them over for this. They're telling me X, Y, Z, but I have to think there's it, a little bit more of a backstory. So I think it goes both ways. I don't know how that looks, but I, I think that's a great idea.

Stacey Shoman, MSN, CPNP: And I would love it, you know, even if we may have a kid that comes through the ER for something and gets admitted for say, God forbid, leukemia. And how awesome would it be for that provider to be able to shoot a message out to the primary and be like, Hey, just want to know, I mean, we will eventually see that note, but just to kind of fill us in personally, let us know how they're doing, let us know their thought, that kind of thing.

Or like you said, if you have a question, yeah, often there's a lot of stuff that doesn't come through on the referral that you may want to know. That I would love to, I'd love to be able to discuss patients with you guys. And obviously it would have to be a secure, you know, browser and email system, but I wonder if there's not a way that could be done through the patient portal my patient connections.

Host 2: Stacey, I see a project coming in our future.

Stacey Shoman, MSN, CPNP: Yes, I

Host 1: I love

Stacey Shoman, MSN, CPNP: I have talked about this before, Trisha.

Host 1: Yeah, we have talked about it. Stacey and I were at a conference together and kind of brainstormed a little bit, but I look forward to navigating these waters with you and seeing what we can bring to fruition because I think it's a very important piece of the collaboration. And we're all about having collaborative practice and having this health care team to include the subspecialties, the primary care, and most importantly, the patients and the family. So how could we all be connected to be able to provide amazing patient care? So that's something to really look forward to the future to bring to fruition.

Stacey Shoman, MSN, CPNP: Yeah, absolutely, absolutely. And just kind of keep that personal touch with it a little bit, and be able to communicate between the providers, you know, just a little more informally to kind of discuss the patients, without having to page you, you know?

Host 1: Yeah, I love that idea. I love it. There has to be a way. We gotta figure it out.

Stacey Shoman, MSN, CPNP: I know. We need the tech people in on this because that's definitely not me.

Host 1: Not me either.

Host 2: You know, I will say, Stacey, as I was hearing you see the things that you love about working in the community, I can see how you are just, as I mentioned earlier, just super invested in these kids and their families. Like, you know them, you see them at the store.

Stacey Shoman, MSN, CPNP: Yes, it's

Host 2: they are part. You are part of their lives, so it makes sense that you want to know what happened. Like, you know, I think sometimes once they get to us, we're like, oh, it's fine. Like, let's just get this done. But we kind of forget that we have a primary care provider who's kind of their home that want to know like what happened. And love that you want to know that. I think that shows how much the primary care team cares and is part of the patient's life.

Stacey Shoman, MSN, CPNP: Right. And even on the inpatient side, you know, there have been times in the past where we'll have a family admitted for something. And they may, or may not be, they might be upset with something that's happening on the inpatient side. And they're calling us. And it's interesting because there's really not much power we have at that point, right?

But it'd be great to be able to say, hey, red team, or hey, blue team, like, reach out to them and be like, hey, this mom is contacting us, just wanted to reach out without pulling them out of rounds. Or they may even be off, not at work at that point. But just to be able to reach out and be like, hey, we're getting some feedback from this mom, let me know what you're thinking with this, right?

Because we don't always know. We don't always see a progress note for a couple days that's posted in the portal. So we don't always know what the line of thinking is. So that would be great, even on the inpatient side, to be able to reach out to somebody without having to page them and pull them out of what they're doing at the time.

Host 1: Right, you know, and the family has such quick access to their primary care providers, you know, so of course, and there's that trusting relationship. So, of course, they're going to reach out to you and if you guys could help them navigate their waters of their inpatient stay or their subspecialty visits.

Stacey Shoman, MSN, CPNP: Right.

Host 1: You know, definitely, I mean, there's definitely room for improvement there and, and to help with that collaboration.

Stacey Shoman, MSN, CPNP: Right. Absolutely. Absolutely.

Host 1: You know, Stacey, I think that we have a good start on some potential collaboration and work here. But, you know, as specifically a subspecialist, Tobie and I, as our listeners know, are ENT specialists. Like, what are things or ways that Children's Mercy's subspeciality nurse practitioners or physician's assistants can do for our community advanced practice providers?

Like we really want to tap into that network and see what we can do to help and also learn from you guys on what you can bring to the table as well. So do you see any type of things that we can do to navigate waters together?

Stacey Shoman, MSN, CPNP: Yeah, so one of the things that was amazing several years back when I was at my old office, one of the I can't even remember what subspecialist was, they put out a workbook, a cheat sheet. It was, I think it was Endocrine, and it was a cheat sheet of labs that we could do. Because when you look at a lot of the things that we refer to primary care, some of it we can manage.

So right now we're looking at this big backlog in neurology because of everything going on with neurology and you guys absorbing a lot of the neurology patients from the community now. And so, we can manage migraines, but we don't always know, hey, what were you guys using preventatively for migraines?

What abortive meds were you using for migraines? Those are things we can manage, we're just not very comfortable with them. GYN, PCOS labs, things like that. There's ENT items like, hey, what's the first drop you use? At what point do you go to oral antibiotics? What happens when you culture yeast in an ear, which happens to us sometimes?

What are you guys using for that? So I wonder if we couldn't somehow come up with, you know, a clinical practice guideline for each of them, for the commonly used things we see in primary care, especially labs, because some of that we could get started in advance, if it's going to take, because I think one of our patients biggest issues is long wait times, right?

And we know that, that's going to happen. There's nothing we can do about it. But if there's things we could do to get those things kick started, I would love it. I would love each subspecialty to come up with common diagnoses that they get, that they think we could manage, and how they manage them. And that would be so helpful to us, because I don't mind managing them. I often don't know how to, because it's just not in my wheelhouse.

Host 1: Right, yeah, no, I love everything about that. I was like fist pump in the air listening to you say that because, I mean, what an awesome opportunity for us to provide for you guys. And I'm thinking ahead, you know, I'm a big picture lady, like, what can we do? Like, how can we get this going for you? Like, I love everything about this. That's an amazing idea, Stacey.

Uh,

Stacey Shoman, MSN, CPNP: Yeah, no, I would love it. And again, I had a cheat sheet at one point and it's been lost in my move, but I loved it because I would be like, okay, there was a short stature workup. There was a precocious puberty workup. So we would know prior to even getting him into endocrine. Okay, these are all the labs we're going to do.

And even at that point, if we had the portal, system down, where I could just email an endocrinologist and be like, and it's, again, secure, so not a HIPAA violation. Hey, these are these labs, would you even do anything? Is it even worth a referral? And then we may be able to actually save some of these referrals and some of this backlog.

Host 1: Right.

Stacey Shoman, MSN, CPNP: If we could do some of that work on our end, because we're seeing them. GI would be a huge one. Man, we see so many GI kids. Constant stomach pains, constant, you know, constipation, that get referred, but hey, what are the things you guys would do that we could do here? Before we even get to the point of referral.

Host 1: Yeah, those worksheets would be amazing. I think things that we can provide, you know, from Children's Mercy, if you look, you know, kind of at our backlog of podcasts and things, a lot of those subspecialties leave those quick tidbits and information, that you guys can kind of tap into right now. So, if you wanted to share our podcasting information with your colleagues and other community providers, that may be some place to start, but definitely a lot of work to be had with providing you guys with those work throughs.

Stacey Shoman, MSN, CPNP: Yeah, yeah, no, I think that would be wonderful. And it would help you guys too. It would help Children's Mercy take some of that, you know, because again, there's some things you guys are managing that we can manage. And we do often manage. But yeah, I think there's more that we can be doing. Especially on like, headaches, neurology, that kind of thing  and GYN, Endocrine, there's a lot of stuff we can do. But not everyone's comfortable doing it.

Host 1: Right.

Host 2: I think it's great that you are interested and, you know, would be willing to do that. So, yeah, I think it's a great potential project that we could work on. Thank you so much for letting us pick your brain about these sort of things. We were really hoping to kind of figure out a way that we can better collaborate and better support you guys and just, work together to take care of our community kids.

Stacey Shoman, MSN, CPNP: Absolutely, and you guys are doing great things. Yeah, we definitely use you a lot, as you guys know, we're lucky to live in a city, where we do have a local children's hospital, and we do have those resources, so I think we are really lucky to have that, you as a resource.

Host 1: Our patients and families are very lucky, I would agree, to have all of us. .

Stacey Shoman, MSN, CPNP: Yeah, absolutely. Absolutely.

Host 2: Well, Stacey, each podcast episode, we end on a certain question, so here is our question for this season. Okay. Are you ready for it? Okay. What would your younger self high five you for now?

Stacey Shoman, MSN, CPNP: Well, I would say I would high five myself professionally for doing what I always wanted to do. So my whole life, I wanted to be a healthcare provider. You know, when I was younger, I always said I was going to be a pediatrician. I always wanted to work in pediatric medicine. And so I would high five myself for actually doing what I said I was going to do my whole life.

 And not everybody gets to do that, right? And I still love what I do. So I think that's amazing. And so, yeah, I'm pretty proud that I've actually followed through with what I wanted and actually did it.

Host 1: I high five you for that, too, Stacey. And, if you wouldn't have seen your dream come to fruition, I would not have had the ability to learn from you; as you were one of my main preceptors during my practicum and clinical experiences as a nurse practitioner. So I high five you for being such a good role model and teacher for other nurse practitioners as well.

Stacey Shoman, MSN, CPNP: Oh, well, thank you. You were an amazing student.

Host 1: Aw, thanks.

Host 2: Well, thanks again, Stacey. It was really nice chatting with you.

Stacey Shoman, MSN, CPNP: Thank you, ladies.

(Outro): If you have a topic that you would like to hear about, or you're interested in being a guest, you can email us at tdobrien@cmh.edu or twilliams@cmh.edu. Once again, thanks so much for listening to the Advanced Practice Perspectives podcast.